It crossed my mind that only a “birthjunkie” would be SO excited to be invited to a sacred placenta burial ceremony, but I was! This placenta traveled all the way from Norway 8 months after its birth to be buried in a holy place!
Since my lotus birth ( https://gaurilowe.wordpress.com/2014/06/25/my-home-and-water-and-lotus-birth-part-2/ ) my appreciation and respect for the placenta has grown. As well as my awe for its natural beauty and presence. It is a phenomenal, often missed, tree of life – life-sustaining organ.
So this placenta was born via an emergency caeserian and has made it all the way to Sridham Mayapur, a holy city in East India, to be buried on the banks of the River Ganges (also known as Mother Ganga). This was to honour the placenta that had been a close maintainer of her babies life.
It was a small, casual and sweet ceremony. We found a quiet spot, dug a deep hole, close to the water and buried the placenta with the cord curled upwards, placing some flowers over it, while quietly chanting some sacred mantras.
The Western Cape – home to about 10% of South Africa’s population. Between 1999 and 2007 the amount of live births increased from 70 000 to 99 000. About 5% of maternal deaths in South Africa are from the Western Cape. Most deaths are caused by non-pregnancy related illness like HIV and next hypertensive disorders in pregnancy. But I am not going to dwell on statistics of mortality. Although it is sobering to always remember that pregnancy carries risks and moms can die!
I want to give you a flavour of my experience in the PUBLIC sector of Birth in the Western Cape – full of diversity and discrepancy – first some practical insight of the structure of birth in the Western Cape.
Public – you sit in a waiting room half a day to be one of about 60 mothers seen by 2 doctors. (Numbers vary and increase at different hospitals.) You have an ultrasound – if you are lucky – only when it is indicated.
Private – you make your appointment, pay at least R500, have an ultrasound at EVERY appointment indicated or not and you wait a little. But you actually have about the same amount of time with your gynae.
Private midwives – you have your appointment, pay less, and have far more time with your midwife where you discuss deep subjects – your own birth perhaps, your home situation, stressors and how you are really feeling and coping.
Describing the delivery is also a similar exercise.
Which make talking about birth in the Western Cape open to several different angles.
I would like to give a very raw flavour of what birth in the western cape has been for me in my last few years in medicine.
A young girl – it was her 18th birthday. It was also Valentines day. She was wheeled in on an ambulance stretcher with her baby almost crowning. She was small and wearing a mini skirt and had been out with her boyfriend at the waterfront. Her baby girl was born quickly and she breastfed. Then we found out she did not want to keep the baby. Her boyfriend told us that 9 months ago she was raped. She believed her pregnant belly was a cyst, as she said she was told by her doctor. Therefore she had NO antenatal care. Her baby went up to the nursery, to prepare for adoption, and she went to the gynae ward.
Read more here: http://drgaurilowe.com/blog/birth-in-the-western-cape
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Hospitals never conjure up a “nice” experience for people. But this episode took human rights in childbirth to another level.
I mean, I thought basic hygiene and cleanliness would be a a basic expectation, from years and years of history and practice.
Alas, these basics were sorely missing in this government hospital in West Bengal, India. As we drove up at 3am the people lining the driveway and outside area stayed asleep as we moved swiftly into the hospital. The metal trolley for an examination bed was cold and stark. The trolley with wheels for moving around was presented to us with fresh and old blood stains. They wiped them away, once we requested them to, before we placed our sheet over the trolley under our patient.
And made our way to the labour room to see the gynaecologist – passing all the ladies on either side of the passage…in various stages of labour, taking up the space on the floor that their bottoms or feet touched. Body to body, no space – the passages were full. Lying over, alongside, curled across another lady – perhaps their friend or mother who was assisting them. When their labour pains got too much it seemed like a hospital assistant came over and sat with her, checking by looking under her skirt with her eyes only. They continued labouring on their colourful plastic sheet – in silence. But their eyes screamed loudly.
We took our shoes off before going into the labour room – as requested. And the doctor treated us nicely, sensitively and respectfully. We also had to take our shoes off to enter the theatre area. And I stepped on a needle, luckily noticing it before it could pierce me. On pointing it out to someone they helpfully pushed it further away under the trolley so it would not harm me…
The postnatal ward was another experience. Beds filled with new mothers, their assistants (a mother, a friend or a sister) and the new babies. All on their own yellow or pink striped plastic sheet they had bought outside at the stall. This was their only protection, as they lay on the hard grass mattress. The nurse came to give pain medication and antibiotics as prescribed. The doctor came a couple of times and felt a pulse and asked if “anything something” was needed? Like pain medication? No blood pressure was taken. No temperature. No bleeding or wound checks were done. Urine catheter bags were emptied.
I looked for a basin to wash my hands. The one in the corner’s tap didn’t work. The bathroom smelled so strongly of urine and I couldn’t bring myself to walk past the heaps of bloody cloth in several piles along the wall. I found a tap in a sideroom with half-filled plates of yesterdays meals on it.
When I came back the Chai – walla was walking up and down with his hot kettle pouring chai for whoever wanted. Mothers and mothers shared beds with their babies and carers. Carers (as in the mother’s sister, mother or friend) helped new mothers latch their babies.
We gathered a crowd at times and had to manually disperse them. They wanted us to stay for 7 days after the caeserian until the stitches were removed. I guess that is how long all these people stayed. We left earlier actually to continue hygienic monitoring at home.
Is this a financial issue?
Is it a social awareness issue?
It is a basic human right to sanitation.
The services are free – following the government’s Janani suraksha yojana implementation. Free pregnancy and birth (including caeserian section) services in public hospitals to encourage hospital births in attempt to decrease the perinatal mortality rates.
My concern truly is how safe and healthy is it really?
At the Midwifery and Birth Conference 2014 in Cape Town my topic for my presentation was “The Balance Between the Medical and Midwifery Model of Birth”. Contemplating this topic – I realised the vastness, politics and definitions of it.
Below is my talk in text and audible on the video presentation. Please sit back, have a listen and consider the proposal of a Sacred Model of Birth.
After my presentation, a lovely midwife, who honours birth space very wonderfully, approached me and asked a question, “That is very nice and I agree – but HOW do you do that in certain circumstances?”
After some consideration – here is my answer:- That a sacred model of birth lies not only in the practical considerations, but is mostly lying in our inner PRECENSE that we are holding at each moment. It does not depend on the birth outcome, nor the procedure we are doing, or not doing – inherently it is lying with our inner attitude and precense – that can give itself to honouring each moment for that lady giving birth. Therefore we continue to act responsibly and safely BuT with a difference of grace, of awareness, of consciousness and being – that lends itself to keeping Birth Sacred.
I do feel that the lurking doubt of HOW to do this is using an element of fear to hide behind and I invite careful consideration and reflection upon this. Fear is present where Love needs to be and it wears a very astute disguise of logic, rationality and horror stories!
I would also like to add that I see this model as being extremely practical and universally applicable. And perhaps a Sacred Model of Birth Manual shall soon follow!
I do not propose inadequate, unprofessional approaches – I support medical and emergency skills and interventions WhEn they are appropriate and I encourage them to be done in a sensitive and respectful manner.
I encourage your opinions, thoughts, doubts and questions – please feel free to comment and I shall reply!
I am here to talk about a balance – between medical and midwifery models of birth and pregnancy care. BUT I came across great obstacles in deliberating that.
I think the “problem” is that I gave birth to my baby in my third year of medical school. I hadn’t done clinical medicine – it remained theoretical biology at that stage.
AND I had an AMAZING birth!! In that birth – I GOT IT!!
I believe a good hearty personal story helps a good talk take root – so here is mine:
It was about 10pm and I was crying at 39.5 weeks that I would be pregnant forever. When bshhhh – my water broke!! Thinking labour would probably start about 12 hours later (like the stories I’d heard), I smsed my midwife and went back to “sleep”…and I lay in bed sleeping between contractions with my beloved next to me, in complete denial that I was in labour!
THIS IS A KEY POINT!!! Remember the key points! (Denial of labour)
And then when I woke up suddenly shaking uncontrollably with each contraction and needing to DO SOMETHING NOW! – was the same time that my midwife called ME to find out how I was – and to come through.
ANOTHER KEY POINT!!! (The feeling to DO something)
By the time my midwife came my baby was just short of crowning and feeling the full intensity of each painful contraction with descent of my baby – and she centred me, grounded and focused me and assisted my husband to physically support me …So – Lochan was born!
I got a few stitches and then snuggled into bed with him for the next few days.
And this bought forth my major obstacle in discussing a balance between a medical and midwifery model of birth.
Because BIRTH IS NOT A Medical Event.
And Birth happens whether the midwife is there or not.
BIRTH IS BETWEEN The Mother and Her Baby.
It IS a matter of Heart.
I really tried – I did several rotations in Obstetrics during medical school, internship and community service in diverse hospitals, MOU’s, saw private mothers, assisted private midwives, homebirths, spoke to many mothers, seen mothers die, seen babies die, seen babies almost die, mothers almost die, labours go bad quickly, labours go bad slowly, caeserian sections turn bad, life-saving procedures – work and not work.
The underlying incentives, attitudes, practices – people want to call models – lack humanity, individuality and truth.
It always comes back to this for me – there is an unacknowledged truth about birth – it works and it empowers.
What model supports that as its core?
The medical paradigm – whether it be doctor or midwives looks through the glasses of fear. Fear of risk of morbidity and mortality and fear or litigation. Protocols and decisions are born from this arena. Which makes them feel very safe as they revolve through the doors of statistics and research reviews. But in a case when you have to do 1100 procedures to prevent one risk, we need to take into account any risk that the procedure may have in turn AND its affect on this women’s future. But we are not speaking about women. We are speaking about numbers. And this is valid and reasonable when working in a busy practice or a busy hospital with high numbers and high morbidities – which you need to “manage”. Or is it?
And a midwife model is typically where the pregnant woman and her midwife have an open, trusting relationship based on mutuality, open information, shared decision making, knowing the pregnant mother deeply as well as her fears and hopes and character.
Still in our reality the midwife model that does exist is still under a banner of the medical model. “My hands are tied…” I have heard them say. They are tied up in a medical model. The medical model holds the power.
Sitting here in your lanyard description as a “midwife, doula, doctor, mother” – cast it off and hear with your heart.
I wish to propose a Sacred Model of Birth.
What if I had to tell you that your work with mothers at this precious time of pregnancy and birth – has the potential to change the innermost face, integrity and empathy of our society?
What if I had to tell you that the emotional, spiritual and physical womb time is the most important time of impact and potential to not only form and grow empathic, secure and confident children but in turn to change society for the good?
The time in the womb – the physical environment, nutritional status, emotional and mental status, stress exposure and connecting with your mother at this time – is profoundly deeply interconnected with your innermost character, insecurities, fears, responses. It shapes how you perceive the world – as a safe and loving place or a place of animosity and danger. Do you greet the world with arms of love or with weapons of protection?
Just imagine this potential? How much intersociety, interpersonal never mind intrapersonal! corruption, crime, psychiatric disorders, basic unhappiness can be prevented at this level?
Consider now – how YOU can support THIS for each of your pregnant clients?
Does this then not become the most important question in pregnancy care? What is your role in assisting your pregnant client to feel SUPPORTED? AMAZING? Like she is part of a huge miracle growing inside her? And she can trust her body to continue?
Can you do that? Or is there some fear-based doubt holding you back?
Now – just for a moment – take off your lanyard. Take off your designated hat. And sit quietly and comfortably. Close your eyes if you like. And place your hand on your heart area. And remember why you are doing the work you are doing? What love, compulsion, pull led you to do this work which is really a calling?
And just allow yourself on every level to remember that feeling. Allow it to soak over you. Feel it in each cell. Listen to it. Taste it. Embrace its colour.
Does it still lead you? Is it based in fear or love?
Let it enter your heart again so it can always be with you as it always is.
Remember this contract you have. An inner work contract. When you are consulting with each mother pregnant or in labour. And act with this responsibility as importantly as the responsibility for safe risk prevention, control and practices.
Now Before you allow your mind to indulge you – I will assist:
WHAT IF! “But so many things can go wrong! What if…..”
The horror stories come bounding in….from the mouths of all you meet (it feels like) – mothers, doctors and midwives. There may be So many costumes, statistics and dramas to convince you to join their plight of Fear Installation.
I am not going to dwell on all the specific “what if’s” and fear-based research. It is glaringly obvious and logical that the medical part of birth and pregnancy is to be there to care for, correct, treat, manage the big what If’s.
It is not to stand by and project the “what if’s” before they have any sign of occurring and interfere to co-ordinate a whole new “what if” picture. There are far better and mother centred ways to prevent risk damage.
It is not to have a whole lot of inflexible protocols that can possibly act to protect the gynae from law suits. Because this does not put the individual mother in the centre and treat her as a unique individual having a baby. As each pregnant patient indeed is. One of the best ways to avoid being sued is to have a really good honest and intergrity based relationship with your client and act soundly with rationale.
The medical place is just that – medical. And until something is medical in a pregnancy and birth the medical place is to be on standby AND support the midwifery model of care.
On that note the midwifery role is to have the skills and education to pick up any risks, prevent any from arising and communicate with the medical. This needs to be balanced in a skilful way from – as quoted in the Journal of Perinatal Education – . 2005 A Midwifery Model of Care for Childbearing Mothers At High Risk: Genuine Care in Caring For The Genuine.
– “allowing mutuality, trust, ongoing dialogue, enduring presence, and shared responsibility while holding the skills of theoretical, practical, intuitive, and reflective knowledge with a special responsibility to balance the natural and medical perspectives in the care of childbearing women at high risk, especially by promoting the woman’s inborn capacity to be a mother and to give birth in a natural manner.”
That is all based on how the birth services in our public setting operate. I want to go even deeper than that to understand from what level of ourselves we are coming to a pregnant client and birth and how important that is.
What does a WOMAN NEEDIN HER PREGNANCY AND HER BIRTH? (whether you are acting under medical or midwifery)
Mid-wife. With Woman.
Yes – the physical checks to exclude pathology, risks and abnormals.
While supporting and educating the healthy and nourishing physical needs to keep healthy and risk-free
She needs to come out of her consultation (with her doctor or midwife) feeling TERRIFIC! COURAGEOUS! HOPEFUL!
And she needs to connect with her baby.
That may sound a little – “yeh, well that is very nice BUT…..” “I saw a woman who was fine and then suddenly developed….” “I had a lady transferred in labour and then…” “I know a lady who suddenly became….” “
But it comes down again and again – to the relationship between caregiver and client. From the beginning if you are able to spend the time getting to know your client – her fears, history, family history, stressors, concerns, character as well as her BP and her urine – the insight you will gain to really journey with her in her pregnancy and birth will serve not only to a healthy and largely risk-prevention birth BUT a deep connection and inner journey for the mother and baby.
I am not being naiive – I have seen the horror stories. And I remain absolutely convinced that the relationship and care for the whole person – in a sacred honouring of the process of pregnancy and birth – is the main stay to a healthy AND satisfying outcome, setting the foundation for years to come!.
Where in these models do we find the place where we can practice TRUST. LOVE. HONOUR. For the process of pregnancy and birth?
If we bring these into our practice –
and allow a woman to – sleep in her comfort zone – in denial (key point) during labour – we allow the body to do its thing. What are we tending to do at this time that could interfere with labour?
What do we do when the pregnant mother “Sits up and wants to (needs to) DO SomETHING! Do we say “yes! Her comes transition…lets move with it…or blow through it…” No – too often I have heard – “Sit Still. Stop being so unco-operative. We can’t get a good tracing. Ok, lets put a catheter in then you don’t have to go to the toilet.”
What else can be expected when you have 2 nurses on your floor in a busy labour ward!
When have we looked into a labouring ladies eyes and met her with love and said “You are doing So beautifully! And your body is just amazing!”
Bringing the Sacred model into birth WILL save lives, save money, save caeserian rates and save staff burnout! Women will give birth to healthier babies, feel better about themselves and becoming a parent and babies will respond!
Just try it.
I would love to hear your views, comments and experiences on this topic. Please leave your comment here or email me https://gaurilowe.wordpress.com/contact/
If you are interested in being kept up to date with sacred model of birth teaching course – for birth workers, health practitioners and interested mothers – pop me a mail.
“A few years ago looking at the many wonderful birth conferences happening around the world, and feeling the disharmony in our birthing world – I started dreaming of a conference in South Africa – using local talent and expertees. I realised this is totally possible and by harnessing and gathering everyone allied, involved, working with birth directly or indirectly and mothers – we could generate a wonderful wave of gentle birth consciousness and potential. So here is our second midwifery and birth conference! Bringing ALL birth people together to learn, share, hear, celebrate and mourn the potential we have to improve birth for our mothers in South Africa. By collaborating on this level – people can be touched and in turn go out to touch more. Birth is not just about delivering your baby – it is about welcoming your family!” Dr Gauri Lowe
Our main goal is to promote sharing and collaboration between birth professionals and the women they serve. Our aim with the yearly conference is to provide a platform on which both birth professionals, mothers and fathers can all come together to discuss and debate relevant topics. We hope that this space will provide fertile ground to inspire and create change in the South African culture of birth – whether encouraging more individuals to become caring, compassionate Doctors and Midwives, to helping find solutions to the deep crises in government maternity care, or to help mothers and fathers find their voice in decisions made at the highest levels.